POS0796-HPR ASSOCIATIONS BETWEEN PAIN REDUCTION AFTER PARTICIPATION IN FIRST-LINE OSTEOARTHRITIS MANAGEMENT PROGRAMS AND PROGRESSION TO JOINT REPLACEMENT: A REGISTER-BASED STUDY OF 44588 PATIENTS WITH HIP OR KNEE OSTEOARTHRITIS
Authors: K. Gustafsson, A. Cronström, O. Rolfson, E. Ageberg, T. Jönsson
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> First-line treatment for people with hip and knee OA is education, exercise, and if needed weight control. It has been shown that people participating in first-line treatment experience positive effects on outcomes such as pain (1-3), health-related quality of life, self-efficacy, and function (3), and may postpone the need for total joint replacement [4]. However, it is still unclear if the results from first-line treatment are associated with progression to joint replacement. <h3>Objectives</h3> To investigate the association between changes in pain after participation in first-line OA management programs and progression to joint replacement in persons with hip and knee OA. <h3>Methods</h3> An observational register-based study. Data from the BOA register was merged with data from the Swedish Arthroplasty Register. The primary prognostic factor was the change in pain between baseline and 3-month follow-up. The pain was measured on a numeric rating scale (NRS). The NRS pain comprises an 11-point scale where 0 indicates no pain and 10 indicates the worst possible pain during the last week. In the current study, pain change was categorized into a) much better (≥2 steps of improvement), b) slightly better (1 step of improvement), c) no change in pain, d) slightly worse (1 step of deterioration) and e) much worse (≥2 steps of deterioration). The main outcome was progression to joint replacement. A Cox regression model was applied to investigate the association between changes in pain and progression to joint replacement and presented with Hazard ratios (HR). <h3>Results</h3> Among patients with hip and knee OA, respectively, 26% (n=3555/13876) and 9% (n=2686/30712) progressed to joint replacement. An improvement in pain was associated with a lower probability of progression to surgery while patients who got worse in pain had an increased probability (Table 1). <h3>Conclusion</h3> Progression to joint replacement after participation in first-line treatments for hip and knee OA is influenced by the change in pain intensity. This implies that patients should participate in first-line treatment before being referred to joint replacement. <h3>References</h3> [1]Coleman S, Briffa NK, Carroll G, Inderjeeth C, Cook N, McQuade J. A randomised controlled trial of a self-management education program for osteoarthritis of the knee delivered by health care professionals. Arthritis research &amp; therapy. 2012;14(1):R21. [2]Jonsson T, Eek F, Dell'Isola A, Dahlberg LE, Ekvall Hansson E. The Better Management of Patients with Osteoarthritis Program: Outcomes after evidence-based education and exercise delivered nationwide in Sweden. PloS one. 2019;14(9):e0222657. [3]Hansson EE, Jonsson-Lundgren M, Ronnheden AM, Sorensson E, Bjarnung A, Dahlberg LE. Effect of an education programme for patients with osteoarthritis in primary care--a randomized controlled trial. BMC musculoskeletal disorders. 2010;11:244. [4]Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Simonsen O, et al. A Randomized, Controlled Trial of Total Knee Replacement. N Engl J Med. 2015;373(17):1597-606. <h3>Characters from table content including title:</h3> <h3>Disclosure of Interests</h3> Kristin Gustafsson: None declared, Anna Cronström: None declared, Ola Rolfson Consultant of: Yes, Novartis advisory board, Grant/research support from: Yes, instituational support, Eva Ageberg: None declared, Therese Jönsson: None declared.